Why Doctor Hopping Is A Major No-No

One trend that doctors are seeing — and it’s not a positive one — is so-called doctor hopping. The practice involves patients constantly bouncing amongst different cosmetic providers in hopes of achieving their aesthetic goals for as little money as possible and with little to no regard for the skill-level or certification of the doctor. “I wish I had a concrete answer as to why so many patients jump from doctor to doctor to doctor, but there are various reasons why it happens,” says Michele Green, MD, a board certified dermatologist and clinical instructor at Mount Sinai Hospital in New York City.

As more people get work done and talk about it, conversations around aesthetic medicine have, in many ways, normalized. “The number of people seeking aesthetic treatments continues to increase,” says Farhad Ardesh MD, a double board certified facial plastic and reconstructive surgeon in Beverly Hills. “Patients see celebrities, friends, and even family members receiving treatments, and they want to look their best, too.” But what these prospective patients often underestimate is the time, cost, and safety precautions involved. Here, top dermatologists, plastic surgeons, and psychologists reflect on the dangerous trend.

The Reasons for Doctor Hopping

As Julius Few, MD, a board certified plastic and reconstructive surgeon in Chicago, explains “most patients jump around between doctors to get the outcome they want independent of the advice they may have received from a trusted authority.” This can quickly spell T-R-O-U-B-L-E. “There are countless ads out there for the impossible, often posted by individuals who are not adequately trained,” he says.

It’s not just advertising that lures consumers to partake in doctor shopping. Social media is a culprit, too. “Instagram, TikTok, and other forms of social media contribute to the desire for everyone to want to look their best,” Dr. Ardesh notes. “Some want to look like their favorite influencers or celebrity and are willing to go to any extreme to achieve that goal.” The problem with social media is that what you see is rarely what you get. “Remember, social media is full of tricks, like great lighting, body positioning and editing with filters and photo editing apps,” he cautions. “These factors create unrealistic expectations that followers try to achieve.”

Another motive for doctor hopping? Being told no. Dr. Few says that if a patient does not like the advice or recommendation given (even if that suggestion is not to do a procedure), they’ll go ahead with it anyways. “I have had hundreds of cases over the past 20 years where a patient will ask for surgery or a cosmetic procedure, and I give them a clear, scientific reason as to why I am not willing to do the procedure; yet, they will go to someone much less experienced who believes they can deliver magic,” he shares. More often than not, he sees those patients again. “In the end, the patient comes back to me wanting to undo or fix what the other surgeon did,” he says.

Similarly, Dr. Green performs a lot of revisions. “Half of the time, I end up fixing the work of another doctor or injector who screws up the patient because the patient — for whatever reason — came to me, then went to see someone else who they’re unhappy with, and then ends up back in my office,” she explains. “It can be a vicious cycle.”

Then, of course, there are the bargain shoppers. “Many of these treatments can be expensive and patients want to find the best deal,” says Roseann Capanna-Hodge, EdD, a psychologist and integrative medical health expert in Ridgewood, CT. “Unfortunately, most of the discounted prices and deals are offered by less experienced providers, and they come at a cost (think: a lack of skills to properly evaluate, plan, and perform the treatment).” The psychological power of a sale runs deep. “Plenty of people hear of a deal or see a promo and, even if they aren’t due for a treatment or really need it, get it done anyway because they can’t pass up the savings,” Dr. Green adds.

The Risky Business of Doctor Hopping

“Those who are desperate to fix their physical appearance often make poor decisions,” says Dr. Capanna-Hodge. “There is a false belief that you can bargain shop for everything — including low-cost medical procedures from unqualified or inexperienced providers.” That desire for a discount often outweighs safety concerns. “Many would rather cut corners instead of investing in a provider that is not only experienced but provides safe quality care,” she notes.

Doctor shopping is more common with noninvasive procedures simply because patients believe it is easier to dupe their provider. But that doesn’t mean it doesn’t apply to surgery as well. And, as Dr. Few explains, the onus is on the doctor to do their due diligence. “Doctors need to play the role of investigative reporter before agreeing to treat these types of patients,” he says. “Often, I insist the patient give me their records from other places of treatment.” Over the years, he’s also learned some telltale signs of prior work. “Even if the patient does not share that they doctor shop, a trick to figure it out is to ask them to lift their brows and squint for signs of Botox®,” Dr. Few explains. “If they have signs of Botox® or previous surgery, I ask why they are not seeing the person who did their original work.”

It's not just the lack of patient-provider honesty that makes doctor hopping problematic. It’s a slippery slope because of the large number of unqualified providers out there. While It’s difficult for patients to categorize an unqualified provider as the real deal, it’s also tricky to distinguish between authentic products, knockoffs and watered-down versions of the original. Any time anything is injected into your face or body, ask to see the bottle and verify that the product is in fact what it is supposed to be. “Usually, someone willing to do this type of thing is cutting corners,” Dr. Few warns. “It’s common for the person claiming to perform Botox® or Xeomin® for $5 a unit (less than the cost of the product) is likely getting it from an illicit place or watering it down so that it does not work as well or for as long as it should.”

Even if a patient is not well-versed in what to look for in a provider, dermatologists and surgeons know what red flags to look for in patients. “I question the ones that see a half-dozen different doctors and say, ‘no one is good,’” Dr. Green says. “Why has one patient been to so many doctors in a short time? What is the underlying reason why they can’t stick to a single doctor?”

Dr. Few also keeps an eye on patients who talk about all the various places and doctors who have treated them. “This is a red flag,” he cautions. For some, doctor hopping is a way of life, but it’s like playing Russian roulette. “When doctors and services are treated as commodities such as purchasing groceries or gas, you may not receive the best outcome,” Dr. Ardesh says. “Aesthetics is still a part of medicine and it should be treated as such.”

The Dangers of Doctor Hopping

There are serious consequences — some even life-threatening — that can result from doctor shopping. “One little mistake and your life can be in danger and the damage will be permanent,” Dr. Capanna-Hodge says. “When it comes to cosmetic procedures, it’s best to think about why you’re getting the procedure, what it will do for you in terms of happiness, confidence, etc., and research the most qualified provider.” While finances will obviously play a role in the decision making process, don’t let budget be the deciding factor. “If money is an issue, then reconsider your options and revisit when you have the funds to do so,” she suggests.

Here is just a sampling of the things that can go wrong when patients choose to crowdsource their care or see unqualified providers:

1. An overfilled face that appears distorted

The entire face is fair game for overfilling, though the lips and cheeks usually take center stage. Some patients chase an overly plump aesthetic and seek out multiple doctors and rounds of treatments to obtain their ideal look. Poor technique is also often apparent. “Recently, I saw a patient who had her temples injected by another provider,” Dr. Green shares. “One side of her face looked injected, the other looked hollow. Needless to say, she wasn’t happy, and I had to correct it.”

2. A blue-ish tint to the under-eye skin

Injecting filler under the eyes can erase hollowness and give an instant refresh, but, if the product is placed too superficially or the wrong filler is used, the skin can appear blue. Known as the Tyndall effect, the only way to reverse the pigment is by dissolving the hyaluronic acid-based filler with an enzyme called hyaluronidase.

3. Excessive scarring

Scars are an expected part of any surgery, but abnormal scarring (think: those that are painful, extremely thick, and easily infected) are not the norm and require patience, time, and TLC to correct.

4. Hard-to-fix lumps and nodules

Here’s another reason why you shouldn’t let just anyone inject you, and why you should only do what is necessary, when it’s necessary: lumps and nodules. An overabundance of product (or the wrong product) can cause asymmetries, lumps, bumps, and nodules. If hyaluronic acid is used, it can usually be reversed. But with biostimulatory injectables or products like silicone that are not approved by the United States Food and Drug Administration (FDA), there’s little to nothing that can be done to correct the issue.

5. Painful hematomas & seromas

Although hematomas only occur in about 1 percent of breast augmentation surgeries, they can develop from any type of cosmetic surgery. Hematomas, which are pockets of blood that collect outside of the blood vessels, resemble a large, dark bruise, are painful and require additional procedures to remedy. Seromas, which are a pooling of fluid under the skin, can also form when surgery is performed by an unqualified surgeon.

6. Skin that displays signs of hyperpigmentation

It’s not just injectables and fillers that can cause problems — lasers, in the wrong hands and without proper understanding of the patient’s skin tone, can be dicey, too. If the wrong setting is used on darker skin tones or those that have certain undertones, hard-to-fix hyperpigmentation and melasma can easily ensue. “A patient may be of Asian or Mediterranean descent, but they may not look it, or they have darker undertones in their skin,” Dr. Green explains. “If a patient’s true skin type isn’t considered when it should be, the wrong device is used or the setting is placed too high for their skin, they will pigment.” When that happens, there is no easy remedy. “Some patients end up with melasma, which isn’t an easy fix,” she says. “Correcting pigment takes a very long time and a series of peels, lots of topicals, and other treatments to rectify the discoloration.”

7. Loss of mobility

Although it is rare, permanent loss of mobility, both to the face and body, can occur after surgery. “I have seen patients who are not candidates for blepharoplasty have surgery and, in the end, are unable to close their eyes because the surgeon did not have enough experience to know better,” Dr. Few recalls. “It is critical to always ask what the risks and the benefits are.” The way he sees it, the onus is on board certified surgeons to properly assess prospective patients. “If someone the doctor hops, it’s the doctor’s responsibility to slam on the brakes and make sure you know what is going on,” he says.

8. Permanent disfigurement

Perhaps the most severe and debilitating side effect is permanent disfigurement, which can be a complication of both surgical and non-surgical procedures. Nerve damage, permanent numbness, and tingling that doesn’t subside can be serious long-term effects, and there’s also the rare complication of blindness if filler is injected into an artery.

The Takeaway

We get one body, and aesthetic treatments to enhance it are not a place to cut corners. While there is always a chance that complications can arise from any procedure — invasive or non-invasive — even in the most qualified hands, finding a board certified doctor or surgeon who specializes in the treatment(s) you are interested in and understands your aesthetic goals is the best way to minimize risk. At the end of the day, there is little to gain but a whole lot to lose from rolling the dice with your care.